First-trimester abortions are as safe when performed by trained nurse practitioners, physician assistants and certified nurse midwives as when conducted by physicians, according to a six-year study.
Publication of the findings comes a week before the 40th anniversary of Roe v. Wade, the landmark Supreme Court decision that made abortion legal in the United States. A patchwork of state regulations determines who can provide abortions, with many states specifically prohibiting non-physician clinicians from performing the procedure.
The study was designed to evaluate the safety of early aspiration abortions when performed by nurse practitioners, physician assistants and certified nurse midwives trained in the procedure. The study was conducted by researchers with the University of California, San Francisco, under a legal waiver from the Health Workforce Pilot Projects Program, a division of the California Office of Statewide Health Planning and Development. (California law requires a legal clarification about who can perform aspiration abortions.)
The results show the pool of abortion providers could be safely expanded beyond physicians to include other trained healthcare professionals. Nationally, 92% of abortions take place in the first trimester, but previous studies have found black, uninsured and low-income women continue to have less access to this care, according to the researchers. In California, 13% of women using state Medicaid insurance obtain abortions after the first trimester.
In the study, 40 nurse practitioners, certified nurse midwives and physician assistants from four Planned Parenthood affiliates and from Kaiser Permanente of Northern California were trained to perform aspiration abortions. They were compared to a group of nearly 100 physicians, who had an average of 14 years of experience providing abortions.
Altogether, 5,675 abortions were performed in the study by nurse practitioners, certified nurse midwives and physician assistants, compared with 5,812 abortions by physicians. The abortions were performed between August 2007 and August 2011 at 22 clinical facilities in California.
The researchers found that both groups of abortion providers had a complication rate of less than 2%, including incomplete abortions, minor infection and pain. Statistically, according to the researchers, the complication rates were not different between the two groups of providers.
“The value of this study extends beyond the question of who can safely perform aspiration abortion services in California because it provides an example of how research can be used to answer relevant healthcare policy issues,” said Diana Taylor, RNP, PhD, a study co-author and professor emeritus in the UCSF School of Nursing. “As the demand for cost-effective healthcare increases, workforce development has become a key component of healthcare reform. All qualified health professionals should perform clinical care to the fullest extent of their education and competency.”
The study is scheduled for publication in the American Journal of Public Health. The study abstract is available at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301159.